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F C' <br /> jAb ✓ X • — <br /> C> >n <br /> SAN JOAQUIN Environmental Health Department <br /> COTTAGE FOOD OPERATIONS (CFO) <br /> REGISTRATION/PERMITTING RENEWAL FORM <br /> cro 2, Nam <br /> Da.nGre's Christmas Toffee �"oma- Ont <br /> Danielle Especial 2/2/2021 <br /> CFO F'n5 N nE llio CFO Crty. GFO zp. <br /> 23175 N. Elliott rd Acam o <br /> wrosite of applicable) 95220 <br /> Taleplbrp <br /> 2(]96637374 <br /> 1_ Categories: <br /> 'Class A-(Dimct Sales only)5155 lJ 'Class a'(Direct R Indirect Sales)S310 �p p I� <br /> 2.. Prohibited Items: Initial it you agree to abide by the followi� �sr�-J-�! <br /> Foods containing cream, custard,or meat fillings are potentially hazardous and ate NOT ALLOWED. Onlyy <br /> foods that are defined as 'non-potentially hazardousare approved for preparation by a Cottage Food Operibod. <br /> These locos include items that do not require refrigeration to keep them sate <br /> cause of Ieod-borne illnessfrom bacterial growth that could be a <br /> . <br /> 3. Products: <br /> Provide a list of all products you are preparing. If preparingjams.jellies,or(rust butters include a list of <br /> ingredients(attach separate page it needed). <br /> 11 Food List: <br /> Chocolate almond toffee Almonds, butter,sugar,milk chocolate vanilla,sal <br /> Chocolate hot cocoa bombs _Chocolate,sugar,vanilla, salt, white chocolate and rr <br /> 4. Product Labeling: <br /> Attach two labels to this form for two of your CFO products(only one label is required it only one product is <br /> made). <br /> S. Water Source- <br /> Please check what type of water source is being used at the CFO: <br /> ❑City water ® Private Well' <br /> •ll a private well,attach all updated water sample results(including quarterly bacteria and Nitrate resuirs.) <br /> 6. Food Processor Course: <br /> Attach food handler cerbtication far owner and each individual that were not submitted with initial application <br /> (including family members and/or employees). <br /> 1868 E Hazelton Avenue i Stockton.California 95205 1 T 209 468 3420i F 209 464-0138 wuryvsp:.chdcom <br />